Post-transplant lymphoproliferative disease and other Epstein-Barr virus diseases in allogeneic haematopoietic stem cell transplantation after introduction of monitoring of viral load by polymerase chain reaction

• Published in: Scandinavian journal of infectious diseases Vol. 39; no. 3; pp. 235 - 244
• Main Authors: Kinch, Amelie, Öberg, Gunnar, Arvidson, Johan, Falk, Kerstin I., Linde, Annika, Pauksens, Karlis
• Format: Journal Article
• Language: English
• Published: Basingstoke Informa UK Ltd 2007; Taylor & Francis
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Epstein-Barr virus; Epstein-Barr Virus Infections - blood; Epstein-Barr Virus Infections - diagnosis; Epstein-Barr Virus Infections - drug therapy; Epstein-Barr Virus Infections - etiology; Female; Hematopoietic Stem Cell Transplantation - adverse effects; Herpesvirus 4, Human - isolation & purification; Humans; Infant; Lymphoproliferative Disorders - blood; Lymphoproliferative Disorders - diagnosis; Lymphoproliferative Disorders - drug therapy; Lymphoproliferative Disorders - etiology; Male; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Polymerase Chain Reaction - methods; Risk Factors; Rituximab; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous; Viral Load; Viremia - diagnosis; Viremia - etiology; Viremia - virology; Gammaherpesvirinae; Virus; Infection; Polymerase chain reaction; Microbiological investigation; Surveillance; Posttransplant lymphoproliferative disorder; Herpesviridae; Stem cell transplantation; Epstein Barr virus; Molecular biology; Viral load
• ISSN: 0036-5548; 1651-1980; 1651-1980
• DOI: 10.1080/00365540600978906

The clinical value of monitoring of Epstein-Barr virus (EBV) viraemia by quantitative polymerase chain reaction during 1 y was evaluated. 39 recipients of allogeneic hematopoietic stem cell transplantation (SCT) were followed. More than 100 EBV genome equivalents (gEq)/ml in blood or plasma were found in 16/39 patients (41%) at 34 d (range 1-139) post-transplant. Seven of these 16 patients developed EBV disease; 3 post-transplant lymphoproliferative disease (PTLD), 1 myelitis, 1 encephalitis and 2 reactivations with fever. EBV diseases were only found in the high-risk group among recipients of mismatched related or unrelated donor grafts or in patients who underwent reduced-intensity conditioning. In this group, 3/20 (15%) developed PTLD. Conditioning with antithymocyte globulin was significantly associated with EBV disease (p<0.01). EBV load in plasma was more strongly associated with EBV disease than viral load in blood. A cut-off level of 1000 gEq/ml plasma distinguished EBV disease from asymptomatic viraemia, but not PTLD from other EBV diseases. Weekly monitoring of EBV load in plasma in high-risk patients in the first 3 months following SCT seems to be of value for prediction of EBV disease. Therapy for PTLD including rituximab was evaluated during 2 y and showed response in 4/6 cases.